Developing dermatology video consultations: a determination of quality

ABSTRACT

The COVID-19 pandemic precipitated a unique set of circumstances where the provision of care via telemedicine was rapidly adopted. Delivering high-quality care is a primary focus and the consideration of sustainability should be central to this process. Value in healthcare is often defined by outcomes for patients and populations in relation to economic costs;however, a more holistic approach using the 'triple bottom line' factors in environmental and societal impacts. The primary drivers in developing dermatology video consultations were the promotion of equitable and co-produced care, constructing sustainable healthcare and mitigating against environmental impacts, and demonstrating leadership in establishing new methods of outpatient care delivery. Patient video consultation demographics and outcomes were captured from 24 June 2020 to April 11 2020. Data were collected via the hospital software and dictation system with ethical approval. Patient experience was assessed via an online questionnaire. One hundred video consultation episodes were examined. The rate of nonattendance at scheduled video consultation was 10%. Successful video consultations were completed in 90% of patient episodes. Conversion to a telephone consultation was required in 12% and face-to-face presentation in 4%. Further information (e.g. photographs) was required to complete the consultation in 18%. In relation to outcomes, 25% of patients were discharged back to their general practitioner. Day case procedures were arranged in 12% of patients. Follow- up was conducted via telephone in 21% of patients (n = 12/56) and face to face in 79% (n = 44/56). The rate of change in diagnosis following face-to-face follow-up/investigation was 8%. Seventy patients completed an online questionnaire;the response rate was 70%. Mean age was 39 years (range 16-74). Eighty-five per cent were satisfied or very satisfied with their consultation, 83% felt their skin complaint was adequately addressed and 73% rated their overall user experience as very good or excellent. In relation to environmental impacts 12 760 km and 228.6 h of travel time were saved, and carbon emissions were reduced by 2.19 metric tonnes of CO2. In terms of accessibility, 84% of households in the area have fixed broadband and 42% have mobile broadband. When endeavouring to determine the quality of a new service many aspects require attention. Our service demonstrates equity in accessibility with a wide age range and good broadband coverage. The rate of change in diagnosis was low at 8% and patient satisfaction was high. Questionnaire responses provide an opportunity for co-production and positive environmental and societal impacts are also created.